People with symptoms of Rocky Mountain spotted fever should see a doctor – 06/14/2023 – Health

Anyone who was between May 27th and June 11th at Fazenda Santa Margarida, in the Joaquim Egídio district, in Campinas (93 km from São Paulo), and showed symptoms of Rocky Mountain spotted fever, should seek medical attention immediately. In addition, the person must inform the health professional that he was in the region of the outbreak.

The alert was made this Wednesday (14) by the Secretary of Health of São Paulo. Among the symptoms mentioned by the folder are reddish spots, body aches, fever or headache.

Until this Wednesday, there was confirmation that the disease had killed three people who participated in a feijoada at the farm on May 27.

It is also investigated whether the disease killed Erissa Santana, 16, who died this Tuesday (13). She attended the same event.

This Wednesday (15), the Devisa (Department of Health Surveillance) of Campinas claimed to have been notified of two more suspected cases of Rocky Mountain spotted fever. Both patients are hospitalized.

One of them is that of a resident of Hortolândia, a city neighboring Campinas. The 40-year-old woman participated in the feijoada organized at the end of May.

The other is also from a resident of the same municipality. The 38-year-old patient was at Fazenda Santa Margarida at a concert by singer Seu Jorge, held on the 3rd.

The musical performance, according to the City of Campinas, brought together 8,000 to 10,000 people. The organizer, according to the municipal management, did not know how to specify the exact public. Seo Rosa’s Feijoada brought around 3,500 people to the farm.

Spotted fever is an infectious disease transmitted by the star tick. If not discovered in time, the patient can progress to death between the 5th and 15th day after the onset of symptoms.

“Of the 12 confirmed cases of the disease this year in the state, three were people who were at the events held in the place”, says the secretariat.

“In this way, it is important that everyone who has visited the farm is aware of the symptoms and communicates it to the medical service. This information is essential to provide early treatment and prevent the disease from worsening”, says the state folder.

“When venturing into forest and waterfall regions, it is important to be aware that we are in the star tick reproduction period, with the risk of transmission of Rocky Mountain spotted fever through its bite. If within 15 days of this displacement, you have symptoms should seek medical attention as soon as possible”, says Tatiana Lang, Director of the Center for Epidemiological Surveillance of the State of São Paulo.

The incubation period of the bacteria, when symptoms may appear, takes up to 14 days and professionals need to be attentive to the treatment.

“In the initial phase, the symptoms are similar to several other diseases, we need to sensitize health professionals to the window of opportunity for the hypothesis of spotted fever and treatment, as they confuse it with dengue, Covid. If you do not treat it in the first three days, the disease passes to another phase and affects all the organs that have blood flow, evolves to dysfunction of multiple organs, generates lesions in the organs. Between 8 and 10 days, from the symptoms, the risk of death is great”, warned Andrea von Zuben, director of Devisa, from Campinas, at a press conference this Wednesday.

Rocky Mountain spotted fever is known to be very lethal. Therefore, a quick diagnosis so that antibiotic treatment can be started immediately is essential.

Data indicate that the lethality of the disease can exceed 50%. Covid-19, for example, did not exceed the rate of 7% in Brazil, even before vaccination.

According to the State Government, the regions with the highest frequency of cases are Campinas, Piracicaba, Assis and Sorocaba.

The Campinas farm is considered the likely site of infection, according to the city hall, which classifies the situation as an outbreak of the disease.

According to the city hall, the farm will only be able to hold new events when it presents an environmental and communication contingency plan”, said the municipal management.

In the next few days, Campinas will publish a decree with rules for establishments that hold events for large audiences and that are in risk areas or with the presence of the star tick.

The decree will determine that those responsible for events in these places need to ensure the correct information, communication and mobilization of people in relation to the disease, in addition to disclosing ways to prevent contagion.

This Wednesday, a determination was made in the municipality so that every area at risk for Rocky Mountain spotted fever has information about the disease, with posters, banners, signs and other communication devices about the danger.

The Seo Rosa restaurant, responsible for the event at the farm, said it learned of the “fatality”, but that “it is not confirmed that they caught the tick on the spot”.

On Tuesday night, the feijoada organization declared, in a note published on a social network, “its deep regret, solidarity with the bereaved families and friends”.

WHAT IS SPOTTED FEVER?

Acute febrile infectious disease transmitted by ticks infected by the bacterium Rickettsia rickettsii, present mainly in the star tick. The ticks that transmit Rickettsia are called Amblyomma cajennense and are found throughout the national territory. For transmission to occur, the tick needs to be attached to the skin for at least four hours. There is no transmission from person to person.

According to the Ministry of Health, in Brazil, two Rickettsia species are associated with Rocky Mountain spotted fever: rickettsii, considered a serious disease, registered in the north of the state of Paraná and in the states of the Southeast Region; and parkeri, which has been registered in environments of the Atlantic Forest (Rio Grande do Sul, Santa Catarina, Bahia and Ceará), linked to less severe clinical conditions.

WHAT ARE THE SYMPTOMS?

The symptoms are, at first, sudden: high fever, pain in the body, in the head, prostration, loss of appetite, nausea, vomiting and the appearance of reddish spots mainly on the hands and feet, from the second to the fifth day, which can progress to petechiae (small red spots on the skin that resemble mosquito bites) and ecchymosis (purple spots). The disease has mild and severe forms, including hemorrhagic, with evolution to death. The fatality rate can exceed 50%.

TREATMENT

Antibiotics are administered —tetracycline, doxycycline and chloramphenicol— which prevent the proliferation of bacteria, containing the worsening of the disease. The use of medication should already be done even before confirmation of the result.

HOW LONG DOES IT TAKE FOR THE PATIENT’S CONDITION TO DEATH?

The individual can progress to death between the 5th and 15th day after the onset of symptoms. It will depend on the agility in the diagnosis and initiation of treatment. Rocky Mountain spotted fever is difficult to diagnose because it has nonspecific symptoms that can be confused with other diseases, such as leptospirosis, zika, dengue and meningitis, among others.

CAN ANY TICK TRANSMIT SPOTTED FEVER?

The main ticks that transmit Rocky Mountain spotted fever in Brazil are three: Amblyomma cajennense, Amblyomma cooperi (dubitatum) and Amblyomma aureolatum (yellow dog tick).

In the interior of São Paulo, Rocky Mountain spotted fever is associated with the star tick which, in general, occurs in areas of wild forest and riversides. In general, adult men are more affected, as they work in these regions. Nymphs (immature forms of the tick) are the main evolutionary stages involved in transmission and predominate in the colder months.

HOW TO AVOID A TICK BITE?

Those who circulate through endemic areas must wear boots, pants and blouses with long sleeves, covering the whole body. It is important to avoid places with tall weeds.

IS THERE A RISK OF INFECTION IN URBAN AREAS?

Yes. O Amblyomma aureolatum found in dogs is involved in the transmission of the disease in metropolitan regions, mainly in cities in the Southeast and South of the country, where the highest number of cases occurs.

WHAT ARE THE ENDEMIC AREAS IN SÃO PAULO?

Jundiaí, Campinas and Piracicaba, in particular.

REPELLENTS DRIVE AWAY THE DISEASE-TRANSMITTING TICK?

Yes. Icaridin-based repellents are effective not only against mosquito bites but also against ticks, such as the star tick. Long-term presentations ranging from five to 12 hours are available.

Sources: Tania Chaves, infectologist, professor at the Faculty of Medicine at the Federal University of Pará, and Marcelo Simão, infectologist, professor at the Federal University of Uberlândia (MG). Both are consultants to the Brazilian Society of Infectology.